Neoadjuvant treatment strategies for intrahepatic cholangiocarcinoma

Core Tip

Core Tip: Liver resection is the primary component of curative-intent treatment for patients with localized intrahepatic cholangiocarcinoma (ICC). However, a majority of patients present with locally advanced disease and even those who undergo resection are at high risk of recurrence. Neoadjuvant therapy may successfully downstage a subset of patients to resectable disease and improve the long-term outcomes of patients treated with multimodality therapy. As such, the benefits of neoadjuvant treatment strategies aimed at down-staging the tumor and increasing resection rates are of great interest. While high-level evidence regarding the efficacy of neoadjuvant therapy in ICC is lacking, emerging evidence from case control series, as well as recent advances in systemic therapies, liver-directed treatments, and targeted therapies based on an improved understanding of cholangiocarcinogenesis have led to increasing interest in its use.